TY - JOUR
T1 - Etiologies, Predictors, and Economic Impact of 30-Day Readmissions Among Patients With Peripartum Cardiomyopathy
AU - Shah, Mahek
AU - Ram, Pradhum
AU - Lo, Kevin Bryan
AU - Patnaik, Soumya
AU - Patel, Brijesh
AU - Tripathi, Byomesh
AU - Patil, Shantanu
AU - Lu, Marvin
AU - Jorde, Ulrich P.
AU - Figueredo, Vincent M.
N1 - Funding Information:
The study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Database (NRD) of 2013 and 2014, sponsored by the Agency for Healthcare Research and Quality. The NRD is one of the largest publicly available all-payer inpatient databases in the United States, including data on approximately 28 million discharges in the year 2013, estimating >50 million discharges from 21 states with reliable, verified linkage numbers. The NRD represents 49% of total US hospitalizations. Patients were tracked using variable “NRD_visitlink,” and the time between 2 admissions was calculated by subtracting the variable “NRD DaysToEvent.” Time to readmission was calculated by subtracting the length of stay (LOS) of index admissions from the time between 2 admissions. National estimates were produced using sampling weights provided by the sponsor. The details regarding the NRD data are available online (Health Cost and Utilization Project, NRD Description of Data Elements, https://www.hcup-us.ahrq.gov/db/nation/nrd/nrddde.jsp , access date February 22, 2017).
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Peripartum cardiomyopathy (PPCM) is a pregnancy-associated cause of heart failure. Given the significant impact of heart failure on healthcare, we sought to identify etiologies and predictive factors for readmission in PPCM. We queried the 2013 to 2014 National Readmissions Database to identify patients admitted with a diagnosis of PPCM. Patients who were readmitted within 30 days were evaluated to identify etiologies and predictors of readmission. We identified 6,977 index admissions with PPCM. Of the 6,880 (98.6%) patients who survived the index hospitalization, 30-day readmission rate was 13%. Seventy-six percent of readmitted patients were admitted once, and the other 24% were readmitted at least twice within 30 days of discharge. Length of stay was ≥8 days (adjusted odds ratio [aOR] 2.80, 95% confidence interval [CI] 2.08 to 3.77), multiparity (aOR 2.07, 95% CI 1.09 to 3.92), coronary artery disease (aOR 2.28, 95% CI 1.42 to 3.67), and long-term anticoagulation use (aOR 2.51, 95% CI 1.73 to 3.64) were independently associated with increased risk of 30-day readmission. Among the readmissions, 48% were due to cardiac causes, where PPCM and related complications (24%) were the most common cardiac cause followed by heart failure (16%). The annual cost of stay for index admissions was $64.2 million (average cost for index admission was $16,892). The annual charges attributed to readmission within 30 days were ≈$9 million. Cardiac etiologies were the most common cause for 30-day readmissions in PPCM patients, with a readmission rate of 13%. Long-term anticoagulation use, multiparity, coronary disease and length of stay predicted higher 30-day readmission.
AB - Peripartum cardiomyopathy (PPCM) is a pregnancy-associated cause of heart failure. Given the significant impact of heart failure on healthcare, we sought to identify etiologies and predictive factors for readmission in PPCM. We queried the 2013 to 2014 National Readmissions Database to identify patients admitted with a diagnosis of PPCM. Patients who were readmitted within 30 days were evaluated to identify etiologies and predictors of readmission. We identified 6,977 index admissions with PPCM. Of the 6,880 (98.6%) patients who survived the index hospitalization, 30-day readmission rate was 13%. Seventy-six percent of readmitted patients were admitted once, and the other 24% were readmitted at least twice within 30 days of discharge. Length of stay was ≥8 days (adjusted odds ratio [aOR] 2.80, 95% confidence interval [CI] 2.08 to 3.77), multiparity (aOR 2.07, 95% CI 1.09 to 3.92), coronary artery disease (aOR 2.28, 95% CI 1.42 to 3.67), and long-term anticoagulation use (aOR 2.51, 95% CI 1.73 to 3.64) were independently associated with increased risk of 30-day readmission. Among the readmissions, 48% were due to cardiac causes, where PPCM and related complications (24%) were the most common cardiac cause followed by heart failure (16%). The annual cost of stay for index admissions was $64.2 million (average cost for index admission was $16,892). The annual charges attributed to readmission within 30 days were ≈$9 million. Cardiac etiologies were the most common cause for 30-day readmissions in PPCM patients, with a readmission rate of 13%. Long-term anticoagulation use, multiparity, coronary disease and length of stay predicted higher 30-day readmission.
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U2 - 10.1016/j.amjcard.2018.03.018
DO - 10.1016/j.amjcard.2018.03.018
M3 - Article
C2 - 29703438
AN - SCOPUS:85046117857
VL - 122
SP - 156
EP - 165
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 1
ER -